Heard of endo belly – a common and uncomfortable symptom of endometriosis? Dr Suzanne Gilberg-Lenz, expert for Enzymedica UK reveals what endometriosis belly is and how digestive enzymes can help to alleviate symptoms
One in ten women in the UK suffer from endometriosis.
In fact, it’s the second most common gynaecological condition in the UK, and in the US the condition is equally as widespread.
To put it in perspective, endometriosis is as common as diabetes, according to Endometriosis UK.
‘While there are no shortage of treatment options and public awareness campaigns for diabetes, endometriosis has no known cause or cure,’ says Dr Suzanne Gilberg-Lenz, expert for Enzymedica UK.
Causing discomfort that some say rivals labour – endometriosis can wreak serious havoc on a person’s life.
endometriosis is as common as diabetes
Despite the high level of discomfort endometriosis can cause, it is frequently misunderstood as the main symptoms are similar to many other common conditions.
Endometriosis UK suggests that research shows a delay of seven and a half years between seeing a doctor and receiving diagnosis and treatment.
‘That’s unacceptable and a sign of how our patriarchal-centered health care system fails women,’ Dr Gilberg-Lenz asserts.
What is endometriosis?
‘Endometriosis is a condition in which the same type of tissue that lines the uterus ends up elsewhere,’ explains Dr Gilberg-Lenz.
Elsewhere can include the abdomen, ovaries, bowel, pelvic lining, in and around the bladder, and sometimes even beyond.
Hormonal changes throughout the menstrual cycle impact that tissue that has moved elsewhere. As with the uterine lining tissue, it thickens and grows in preparation for fertilisation, and eventually breaks down if pregnancy doesn’t happen.
In the uterus, the tissue is shed during your period. But outside the uterus? It has nowhere to go, so it gets stuck. This is what causes discomfort, an inflammatory response, irritation and sometimes scar tissue.
What is endometriosis belly?
Often mistaken for menstrual cramps, a common symptom of endometriosis is ‘endometriosis belly’ also known as ‘endo belly’.
Endo belly is described as severe and uncomfortable bloating that can last for days or even weeks.
Endometriosis often presents with conditions such as irritable bowel syndrome, coeliac, or SIBO (small intestine bacterial overgrowth), creating a double whammy of discomfort and symptoms.
The discomfort and pressure from this bloating also comes with other life-disrupting symptoms such as fertility challenges, heavy periods, nausea, diarrhoea and constipation.
The discomfort is often written off as period cramps
In one 2009 study, 96 per cent per cent of women with endometriosis reported abdominal bloating.
According to Dr Gilberg-Lenz, endo belly isn’t the kind of bloating where ‘you ate too much and feel a little windy’, but rather ‘people routinely asking you if you’re six months pregnant and you can’t wear trousers comfortably’ type swelling and bloating that doesn’t go away by the morning.
‘The discomfort is often written off as period cramps, routine digestive issues and poor diet choices,’ adds Dr Gilberg-Lenz.
But a 2015 case-cohort study in BMC Women’s Health confirmed that most of those with endometriosis can differentiate between discomfort in the gastro intestinal (GI) tract and discomfort from endometriosis.
Endometriosis and the gut – a vicious cycle
Even without a specific cause to pinpoint, we do know that the immune system plays a role in endometriosis and gut issues.
‘We also know that the gut microbiome plays a key role in both immune and digestive health, so it too influences endometriosis,’ explains Dr Gilberg-Lenz.
women with endometriosis were twice as likely to also experience IBS
In fact, a January 2021 review found that women with endometriosis were twice as likely to also experience IBS.
‘The stress and discomfort from endometriosis turn up the fire on the body’s natural inflammatory responses, which can impact the integrity of the gut lining,’ says Dr Gilberg-Lenz.
‘Once there’s a breach in that protective lining (known as ‘leaky gut’), things that shouldn’t make their way out of the gut (like undigested foods) head out into the abdomen and bloodstream – remember, there’s already irritating endometrial tissue in the abdomen that shouldn’t be there.
‘Endometriosis-induced adhesions and scar tissue can physically impair digestion as well’.
A 2019 systematic review published in BJOG, an International Journal of Obstetrics and Gynaecology, found a ‘complex bidirectional interaction’ between the microbiome and endometriosis – think of it like a ‘chicken or egg’ kind of situation.
‘In a healthy microbiome, the ‘good’ bacteria and microbes keep the ‘bad’ ones in check. But when the microbiome gets off-balance – called ‘dysbiosis’ – the bad ones run wild,’ explains Dr Gilberg-Lenz.
That same 2019 review found that those living with endometriosis were more likely to have increased levels of certain bacteria, including Proteobacteria, Enterobacteriaceae, Streptococcus and E. coli.
Can a nurtured microbiome help ease endo belly?
While a healthy microbiome isn’t the cure for endometriosis, it can go a long way in helping create overall balance and boost digestive and immune health.
It can even boost mood, since the bulk of our serotonin (aka the happy hormone) is made in our gut.
‘Think of your microbiome as a vegetable garden,’ describes Dr Gilberg-Lenz.
diet packed with anti-inflammatory foods further nourishes the microbiome
‘You can’t just go and scatter seeds across your lawn and expect organic vegetables to grow and thrive, you have to till the land, turn the soil, nourish it for optimal health, tend your crops, water and fertilise them regularly and pull out the weeds.
‘Think of your ‘good’ microbes as the vegetables and probiotics and fermented foods like seeds. A healthy, balanced diet packed with anti-inflammatory foods further nourishes the microbiome, helping give it what it needs to recalibrate balance’.
Can digestive enzymes help?
‘Digestive enzymes can play a beneficial role in both easing bloat and achieving homeostasis (maintain stable state) in the gut,’ says Dr Gilberg-Lenz.
Enzymes are necessary catalysts for all the chemical reactions in our bodies. In the gut, we naturally produce enzymes to break down nutrients at specific points in the GI tract.
fruits and vegetables are excellent natural sources
However, as we age we don’t always produce sufficient amounts of the digestive enzymes we need to keep things running smoothly.
Some fruits and vegetables are excellent natural sources containing digestive enzymes including kiwi, papaya, pineapple, bananas, avocado, mangoes and pineapple.
Apple cider vinegar, sauerkraut, kimchi, miso, kefir, yoghurt and honey can help too as they’re also rich in digestive enzymes.
‘To go back to the garden analogy, a gut with adequate digestive enzymes is like a garden where the soil is turned regularly and the weeds are kept in check,’ explains Dr Gilberg-Lenz.
‘Those enzymes are the first line of natural detoxification in the gut. When food moves through at the optimal pace, it doesn’t ferment and break down, leaving ‘clutter’ or ‘weeds’ for the microbiome to have to work around and compete with.
enzymes are the first line of natural detoxification in the gut
‘Digestive enzymes like Enzymedica’s Digest Gold will help to break down all the parts of a typical meal, like fats, fibres, proteins and carbohydrates.
‘This formula is designed to assist with digestion and the assimilation of nutrients, provide relief for occasional gas, bloating and indigestion and can be taken for relief from endometriosis belly bloating’.